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Nursing Change Theory and the Diffusion of Innovation Model
Improvements in delivering quality healthcare services are on the agenda of both private and public structures. There are ample margins left for further development towards more efficient health care. A considerable part of the United States gross domestic product devoted to health care does not result in satisfactory outcomes (Ryan et al., 2015). Implementing initiatives through nursing leadership strategies inspired by innovation theories would enhance results both at unit and facility levels.
This paper will compare and contrast two relevant methods, suggesting how to apply one model of innovation in practice, discussing how to improve a common issue in an interventional radiology department at a public hospital. After the analysis of the theories developed by Kurt Lewin and Everett Rogers, the paper will address the insurgence of complications in percutaneous catheter treatments, applying Lewins approach to implement change within the department culture.
Discussion
Though innovation is vital in every healthcare facility, implementing changes is not always smooth, especially when where the planning is poor and inappropriate, the staff is under-motivated, the leadership is weak, and communication is lacking. Hence, it is crucial to resort to reliable and proven change strategies, which include a well-planned approach, adequate resources, and strong management skills (Bender, 2016). Many researchers have investigated how changes occur, developing planning strategies and development models.
Kurt Lewin pioneered the research already in the early 1950s, proposing a Change Theory were the change agents need to identify and implement three steps to make the changes actual. The stages proposed by the model are: unfreezing, moving, and refreezing. The first step analyzes a current situation and highlights the necessity of a change. The moving phase refers to the involvement of the personnel and the actions taken to implement the change. During the last step, the change is solidified, and new routines and equilibrium are established. The work of Lewin was developed and widened by Everett Rogers in his Diffusion of Innovation model.
Rogers identified five steps for coherent and successful innovation: awareness, interest, evaluation, trial, and adoption. Awareness occurs when an unbalanced situation makes clear the need for change. In the following three phases, interest, evaluation, and trial, leadership and other change agents collect data, involve the personnel, develop a coherent plan, and conduct appropriate tests. Finally, innovations that have proven useful and successful become part of the daily routine in the adoption phase.
The theoretical framework of the two models is similar, and their approach to effective change planning is comparable. The recognition of a problem represents the first step in both theories, and their central core aims at taking adequate actions to solve the issue; while Lewin included the possible procedures within the moving step, Rogers provided a more detailed structure. The final phase of both theories relates to the adoption of the change as part of the ordinary routine.
However, the two approaches feature differences that make them suitable for different purposes. Rogers Diffusion of Innovation allows the change agents to deepen the desired implementation, making this model especially suitable for complex problems which involve different professionals or new technologies (Hunt, 2019). The evaluation and trial phases are paramount to select and adopt new machinery and resources. Lewins Change Theory represents a lean model, especially suitable for educational and research purposes (Scott & Thompson, 2019). The theory allows the leadership to draw a picture of the driving and the opposing forces involved in the change, taking the most appropriate actions.
A Practical Application of the Theory of Change
The theory of Lewin can be utilized to influence and change the culture within healthcare facilities to overcome some typical issues. The hypothetical case refers to an interventional radiology department at a public hospital where multiple noninvasive procedures are performed daily. Complications related to the proper use of percutaneous catheters are quite common, especially among home hospitalized patients. They include leakages, removal of the catheter, complaints, obstructions hindering the proper flushing, or problems with the drainage. Most of the cases are not imputable to healthcare personnel but to the lack of know-how among patients who are not able to deal with catheters properly.
Referring to the Theory of Change, the first step, the unfreezing stage, is the recognition of a lack of education that requires problem-solving (Scott & Thompson, 2019). The second step, the moving stage, refers to the introduction and the implementation of a new practice. In this case, the innovation would consist of properly targeted education of patients for adequate home management of catheters and in making the personnel aware of the potential benefits. It is worthy of observing that targeted educational interventions are becoming a frequent practice in the healthcare environment (Fusco, Armando, Storto, & Mussa, 2016). In the last step, the refreezing stage, the change becomes a habit within the personnel.
In the presented case, the subjects involved are the management of the healthcare facility, the nurse leaders, the nurses, and the patients. Successful implementation of a plan for targeted education planning entails a full awareness of the nurses with regard to both the ongoing program and the results of research grounding the project. The main hindrance to change relates to organizational factors (Foster-Jackson, Anderson-Johnson, & Norman-McPherson, 2016). Weak leadership, the inadequacy of the structure, and lack of support from the management are among the most common perceived barriers.
Summing up, nimbleness and flexibility are among the main benefits of the models, while the dependency on structural factors and the need for excellent communication are the weak points of the theory. A strategy to overcome the downsides consists of incremental changes aimed at creating a strong corporate culture. Such planning should result in a solid awareness capable of influencing the management, whereas the leadership is weak and the structural lacking.
Conclusion
Though innovation is essential in the nursing environment to deliver updated and quality healthcare services, changes are not always easy to be implemented. Several theoretical models have been proposed to attain innovations successfully, including the Theory of Change and the Diffusion of Innovation methods, developed by Lewin and Rogers, respectively. The two models have a similar theoretical approach to change policies, yet they are suitable for different outcomes.
Particularly, the Diffusion of Innovation includes a series of steps that consent to a thorough analysis of the topic, making the model useful to cope with complex changes that entail the introduction of new technology. The Change Theory has a nimble structure which makes the model more suitable for innovations related to educational and corporate culture changes. The proposed hypothetical case has shown the benefits and disadvantages of Lewins model, highlighting a coherent strategy to control the downsides successfully.
References
Bender, M. (2016). Clinical nurse leader integration into practice: Developing theory to guide best practice. Journal of Professional Nursing, 32(1), 3240. Web.
Foster-Jackson, S., Anderson-Johnson, P., & Norman-McPherson, A. (2016). Perceived barriers to research utilization among registered nurses in an urban hospital in Jamaica. Web.
Fusco, F., Armando T., Storto S, & Mussa M. V., (2016). Efficacy of educational intervention for patients wearing peripherally inserted central catheter. A pilot study. Professioni Infermieristiche, 69(1), 17-26. Web.
Hunt, E. (2019). MSN as informaticist. In B. Scott & M. Thompson (Eds), RN to MSN. Principles of professional role development (107-118). New York, NY: Springer.
Ryan, R. W., Harris, K. K., Mattox, L., Singh, O., Camp, M., & Shirey, M. R. (2015). Nursing leader collaboration to drive quality improvement and implementation science. Nursing Administration Quarterly, 39(3), 229238. Web.
Scott, B., & Thompson, M. (2019). MSN as a change agent. In B. Scott & M. Thompson (Eds), RN to MSN. Principles of professional role development (143-118). New York, NY: Springer.
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